title: Anticoagulant and antiplatelet therapy in patients with chronic kidney disease: risks versus benefits review.
abstract: OBJECTIVE
  Atrial fibrillation and cardiovascular death are increased in end-stage renal disease (ESRD) patients compared to the general population. The effect of anticoagulant and antiplatelet medications for these indications in ESRD is unclear. However, both classes of medications have been used for the preservation of vascular access. This review explores the risks and benefits of anticoagulant and antiplatelet medications in ESRD.
  
  
  RESULTS
  ESRD patients with atrial fibrillation have a two and three-fold greater risk of death and stroke, respectively, than ESRD patients without atrial fibrillation. Warfarin does not appear to decrease this risk, and increases the risk of bleeding and vascular calcification. Warfarin also does not appear to be effective for vascular access preservation. In a few large observational studies, antiplatelet agents did not decrease the risk of cardiovascular death, but confounding by indication is likely. Antiplatelet agents do appear to prolong unassisted arteriovenous graft patency, but the effect is modest.
  
  
  CONCLUSIONS
  The role of anticoagulant and antiplatelet agents for atrial fibrillation and cardiovascular disease in ESRD remains unclear. Well designed randomized controlled trials to determine the role of anticoagulation in ESRD patients with atrial fibrillation, and anticoagulant and antiplatelet medications in the preservation of central venous catheter function are required.
authors.affiliation: aUniversity of Ottawa, Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada bRoyal College of Surgeons in Ireland, Dublin, Ireland cUniversity of Ottawa, Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: John P
authors.initials: JP
authors.lastname: Harmon
authors.forename: Danielle L
authors.initials: DL
authors.lastname: Zimmerman
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Zimmerman
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy*; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D062666:Vascular Access Devices / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors